Exploring Medicare Options
While stopping at dad and for a quick visit, you see their mail and all the stuff about Medicare. Dad says all of the insurance information is very confusing and he just wished there was only one choice. Life today is active, especially for women aged 45 – 56 who care for both their parents and children. These people are caught in the “sandwich generation” and these columns are focused on issues affecting you.
The Medicare Plan choices can be confusing, especially during the Annual Enrollment Period from 10/15 - 12/7 every year when people can change plans. This column will address the global options in this and the next issue.
The first information needed is whether your parents have a group plan or must buy their own Medicare Plan. The first choice is to determine if they wish to stay with Original Medicare (OM) or choose a Medicare Advantage Plan (MA). OM is the governmental program started in 1965; MAs are where a private insurance company set up benefits (at least as good as original Medicare), services the plan and pays claims. A number of private companies can offer MAs.
Both OM and MAs have their advantages and disadvantages and it is most important to consider one’s personal situation. To know which one is best for mom and dad, you must understand how OM and MAs work. Most people who have OM buy a gapfiller to pay the co-pays not paid by Medicare. They also buy a Medicare Prescription Drug (Part D) plan. Most commonly, MAs have co-pays, and work much like group insurance with an out of pocket maximum. If the person does not have drug coverage, MAs can include RX coverage. MAs may also include coverage for services not covered by OM such as dental, vision, and hearing. Most MAs also have provider networks and it is important to understand: if you must go to network doctors (HMO) or if a person can go to any Medicare doctor, but the plan plays better for network providers (PPO).
So which type of plan is best for mom and dad? People incurring a lot of medical expense such as oxygen, chemotherapy or having surgery may be best covered under OM and a good gapfiller. Note: MAs have copays – the co-pay for oxygen and chemotherapy may be 20% of the bill up to the out of pocket.
Conversely a person in good health or a person who is no longer going to be aggressive with their treatment may find an MA to work well. In many cases the big difference between the two types of
Medicare Plans is the premium. MAs may have a substantially lower premium.
More information can be found at www.medicare.gov or www.MRMS-INC.com. Talk with qualified insurance agents. Their help can be invaluable and if you pay the same premium if you enroll on-line, but you have the agent’s future help.
Helping mom and dad and caring for your children simultaneously is not easy. It is very helpful to discuss and plan for reasonable future events, and a sandwich generationer should guide their parent through these issues including the primary issue of safety, while being careful not to take all control away from a parent. Once again, it is important to start talking, making suggestions and guiding early, do not wait for a crisis. If you would like a list of “questions to ask in different aspects of care” see our website and look under the “Patient Advocacy Division”.